Florence Nightingale approach 'could help fight infection in modern hospitals'

Her renowned nursing skills were honed on the dirty and chaotic battlefields
of the Crimean war. But Florence Nightingale could still teach modern
hospitals a thing or two about infection control, according to an expert.

Dr Jack Gilbert, head of an international project to categorise all known bugs, said modern hospitals could lower rates of infection by being slightly less sterile. Sterile conditions in wards and operating theatres may be doing more harm than good by wiping out organisms that keep dangerous microbes at bay, he believes.

Opening windows and allowing fresh air into wards could boost populations of "good bacteria" which help keep harmful bug populations under control, he explained.

Dr Gilbert said: "There's a good bacterial community living in hospitals and if you try to wipe out that good bacterial community with sterilisation agents and excessive antibiotic use you actually lay waste to this green field of protective layer.

"Then these bad bacteria can just jump in and start causing hospital borne infections".

The theory mirrors advice from Florence Nightingale who her 1860 work "Notes on Nursing" wrote of the importance of keeping patients' windows open and allowing a breeze in.

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She wrote: "Always air from the air without, and that, too, through those windows through which the air comes freshest. From a closed court, especially if the wind do not blow that way, air may come as stagnant as any from a hall or corridor."

Although her advice was based on the need to clear stagnant air from sick bays and not an early breakthrough in microbiology, Dr Gilbert said it could still hold true.

Speaking at the American Association for the Advancement of Science (AAAS) annual meeting in Vancouver, he said: "Florence Nightingale said if you have an open window where air from the environment is coming in, you'll have less illness."

"You open up these windows, you keep it nice and airy, and you'll see less sick soldiers in this hospital theatre."

Dr Gilbert said a colleague who moved from Chicago to Venezuela had found that his new patients acquired fewer infections even though he was conducting operations at field stations with unsterilised equipment.

A study published last month by University of Oregon scientists found that rooms in clinics where windows were left open had a wider range of bacteria, while those that were kept sealed had a higher proportion of potentially harmful germs.

Prof Mark Enright, a microbiology expert from Bath University, said ensuring a good air flow in hospitals was important, but said that describing them as too clean would be "quite an extreme view".

He said: "Given the opportunity, any bacterium that gets into the bloodstream and into sterile tissue will in invade and cause problems and produce toxins that can kill."

Dr Gilbert delivered his message at the annual meeting of the American Association for the Advancement of Science (AAAS) in Vancouver, Canada.

He said: "You imagine when surgery first started 300 years ago. You'd have people walking around with blood and pus all over their outfits etc. In that situation it makes a lot of sense to make the system very clean. But if you go into any wound infection clinic, speak to any surgeon.

"These guys are constantly exposed to a situation when they sterilise the living bejabers out of their operation room - there's theoretically nothing there, they've scrubbed themselves constantly with sterilisation agents - and somehow magically a pathogen gets into the person when they're in the operating theatre and they get sick.

"This is a situation where one organism from one person that may be a pathogen hasn't had any competition from any other microbes on the skin or in the environment because there's nothing else there. So it's had no barrier to actually go for it."

Dr Gilbert said he had a colleague who carried out field operations in Venezuela using unsterilised surgical instruments that were merely scrubbed with soap and water.

"He sees less acquired infections from surgery in that environment than they do in Chicago," he added.

The potential number of microbes on the planet was estimated to be a "nonillion", Dr Gilbert told the meeting. That is 10 followed by 30 noughts.

No-one knew how many different types of bacteria there were, but he had taken part in a sampling study that found the English Channel alone held around 100,000 species.

"This is a microbial world," he said. "There are a billion more bacterial cells on this earth than there are stars in the known universe. Biological numbers are the big numbers.

"These guys have been around for 3.8 billion years and they're living on every single one of us. There are a hundred trillion bacterial cells in your body and only 10 trillion human cells. You're a lump of flesh.. and these guys have jumped on you and are now living on you and in you and making their living doing it. But without them you'd be dead."